Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Access to Electronic HCR during Outbreak and Assessment of State PHD Immunization Billing Reimbursement Projects New 110 61 0 Form and Instruction 0920-0879 EHR Attachment A_Interview Guide HAI-Epi_041514
Form and Instruction 0920-0879 EHR Attachment B_Interview Guide Counsel
Form and Instruction 0920-0879 EHR Attachment C_Instrument- Word- Phase 1
Form and Instruction 0920-0879 IZPHD Attachment B_Instrument- Web-Phase 1
Form and Instruction 0920-0879 IZPHD Attachment C_Instrument- Word- Phase 1
Form and Instruction 0920-0879 IZPHD Attachment D -Interview Instrument- Phase 2
Assessing Key Factors to Pharmacy Enrollments in the Vaccines for Children Program New 30 24 0 Other-WORD
Cryptosporidiosis: Diagnostic Laboratory and Reporting Practices (CRYPTO) AND Incidents in the National Poison Data System (POISON CENTERS) New 152 30 0 Form and Instruction None CRYPTOSPORIDIOSIS Assessment Tool
Form and Instruction None POISON CENTERS Assessment Tool
Effective Educational Campaigns for Private Well Owners New 100 30 0 Form none Survey screenshots
IZ CORE New 64 64 0 Other-WORD
Improving State and Local Vector Control Program Performance and School Health "Water Toolkit" Assessment New 262 275 0 Form none Vector Control Assessment
Form none Water Toolkit Assessment
Form none Water Feedback
Mobilizing for Action through Planning and Partnerships (MAPP): Outcomes New 506 127 0 Form none Online Assessment
Natinal Public Health Improvement Initiative: Program Assessment New 63 46 0 Other-WORD
Other-WORD
Other-PDF
PH LAW New 1522 152 0 Other-WORD
Other-Screen Shots
PSR New 632 160 0 Other-Web
Other-WORD
Other-WORD
Preparedness for Persons under Investigation for Ebola Virus Disease New 55 11 0 Form none Assessment on Ebola Inquiries and Preparedness
Public Health Improvement Trainings (PHIT) Assessment New 165 28 0 Form none Web instrument
Public Health Performance Assessment & Healthy Homes Needs Assessment New 1784 449 0 Form none PHP Assessment Screenshots
Form and Instruction none HHA Interview Script and Guide REVISED
Reference Labs New 55 9 0 Form none Data Collection Instrument
STLT Ebola-Related Activities New 262 44 0 Other-WORD
Other-Screen Shots
Services and Value of Immunization Info Systems and Public Health Emergency Preparedness Capabilities New 454 435 0 Form none SVIS - Immunization Info Systems Assessment
Form none SVIS - Immunization Info Systems Interview
Form none Public Health Preparedness Capabilities Assessment
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 6216 1945 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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